Navegando por Palavras-chave "Acute necrotizing pancreatitis"
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- ItemSomente MetadadadosDiffusion-weighted magnetic resonance imaging indicates the severity of acute pancreatitis(Springer, 2015-02-01) Tertulino, Franklin de Freitas [UNIFESP]; Schraibman, Vladimir [UNIFESP]; Ardengh, Jose Celso [UNIFESP]; Espirito-Santo, Danilo Cerqueira do [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Apodaca Torrez, Franz Robert [UNIFESP]; Lobo, Edson Jose [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Goldman, Suzan Menasce [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Purpose: To test the use of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between different degrees of severity of acute pancreatitis (AP).Method: Thirty-six patients who underwent DW-MRI and magnetic resonance cholangiopancreatography were divided into patients with mild AP (mAP, n = 15), patients with necrotizing AP (nAP, n = 8), and patients with a normal pancreas (nP, n = 15; controls). the pancreas was divided into head, body, and tail, and each segment was classified according to image features: pattern 1, normal; pattern 2, mild inflammation; and pattern 3, necrosis. Apparent diffusion coefficients (ADCs) were measured in each segment and correlated with clinical diagnoses.Results: A total of 108 segments was assessed (three segments per patient). Segments classified as pattern 1 in the nP and mAP groups showed similar ADC values (P = 0.29). ADC values calculated for the pancreatic segments grouped according to the different image patterns (1-3) were significantly different (P < 0.001). Comparisons revealed significant differences in signal intensity between all three patterns (P < 0.05).Conclusions: DW-MRI was a compatible and safe image option to differentiate tissue image patterns in patients with mAP, nAP, and nP, mainly in those with contrain-dications to contrast-enhanced MRI (which is classically required for determining the presence of necrosis) or computed tomography. ADC measures allowed precise differentiation between patterns 1, 2, and 3.
- ItemAcesso aberto (Open Access)Efeitos do etil-piruvato no tratamento da resposta inflamatória da lesão pulmonar na pancreatite aguda necrosante induzida em ratos(Universidade Federal de São Paulo (UNIFESP), 2011-11-24) Matone, Jacques [UNIFESP]; Goldenberg, Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Severe acute pancreatitis (AP) is characterized by hemodynamic alterations and systemic inflammatory response leading to a high mortality rate. In AP the inappropriate activation of pancreatic enzymes plays an important role in pancreas autodigestion and in the inflammatory mechanisms responsible for the systemic response of the disease. Ethyl-pyruvate, a novel antiinflammatory agent, simple derivative of endogenous metabolite, has been shown to improve survival and/or ameliorate organ dysfunction in a wide variety of preclinical models of critical illnesses, such as severe sepsis, acute respiratory distress syndrome and stroke. It was hypothesized that the EP could diminish the systemic response and acute lung injury associated to necrotizing acute pancreatitis. PURPOSE: The aim of the present study was to evaluate if the ethylpyruvate solution could reduce mortality in AP and/or diminish the acute lung injury. METHODS: 40 male rats, weighing between 270 to 330 grams were operated. An experimental model of severe AP by injection of 0,1ml/100g of 2.5% sodium taurocholate into the bilio-pancreatic duct was utilized. The rats were divided into 2 groups of 10 animals each: CT - control (treatment with 50ml/kg of Ringer’s solution, intraperitoneal) and EP (treatment with 50ml/kg of Ringer ethylpyruvate solution, intra-peritoneal), 3 hours following AP induction. After 6 hours, a new infusion of the treatment solution was performed in each group. Two hours later, the animals were killed and the pulmonary parenchyma was resected for biomolecular analysis, consisting of: interleukin, myeloperoxidase, MDA, nitric oxide, metalloproteinases and heat shock protein. In the second part of the experiment, another, 20 rats were randomly divided into EP and CT groups, in order to evaluate a survival comparison between the two groups. RESULTS: There were no significant differences in IL-1B,IL-10, MMP-9, HSP70, nitric oxide, MPO, MDA (lipidic peroxidation) concerning both groups. The levels of IL-6 were significantly diminished in the EP group. Furthermore, the MMP-2 levels were also reduced in the EP group. (p<0,05). The animals from the EP treatment groups had improved survival, when compared to control group. (p<0.05). CONCLUSIONS: The ethyl-pyruvate diminishes acute lung injury inflammatory response in acute pancreatitis and ameliorates survival when compared to control group, in the experimental model of necrotizing acute pancreatitis.
- ItemAcesso aberto (Open Access)Resultados do tratamento da pancreatite aguda grave(Colégio Brasileiro de Cirurgiões, 2012-10-01) Apodaca-Torrez, Franz Robert [UNIFESP]; Lobo, Edson Jose [UNIFESP]; Monteiro, Lilah Maria Carvas [UNIFESP]; Melo, Geraldine Ragot de [UNIFESP]; Goldenberg, Alberto [UNIFESP]; Herani Filho, Benedito [UNIFESP]; Triviño, Tarcisio [UNIFESP]; Lopes Filho, Gaspar de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the results of the Protocol for treatment of patients with severe acute pancreatitis. METHODS: We consecutively analyzed age, gender, etiology, length of hospital stay, type of treatment and mortality of 37 patients with severe acute pancreatitis from January 2002. RESULTS: The patients' ages ranged from 20 to 88 years (average 50 years), 27% were female and 73% male. Mean overall hospital stay was 47 days. Thirteen patients were treated surgically, the average operations per patient was two. There were six deaths among patients undergoing surgical treatment (46%) and two deaths in the group submitted to medical treatment alone (8.3%). The overall mortality was 21%. CONCLUSION: After modification in the form of management of patients with severe acute pancreatitis, there was a decrease in mortality and a trend for conservative management.